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目的探讨胰岛素瘤的诊断和治疗方法。方法回顾性分析南通市瑞慈医院和南通市第一人民医院近15年来治疗的22例胰岛素瘤的临床资料。结果全组22例均有Whipple三联征。术前B超、CT、MRI、门静脉穿刺分段取血胰岛素测定诊断的阳性率分别为15.8%(3/19)、67.5%(10/16)、71.4%(5/7)、100%(2/2),术中B超的诊断阳性率85.7%(6/7)。行肿瘤局部切除13例,胰体尾切除3例,胰体尾切除+脾脏切除1例,胰十二指肠切除1例,保留十二指肠的胰头切除1例,腹腔镜下胰岛素瘤切除3例。22例均为良性肿瘤。术后低血糖症状均消失。结论 Whipple三联征结合IRI/G比例的测定是定性诊断的主要依据。多层螺旋CT双期胰腺薄层扫描是定位诊断的主要手段,术中B超是对术前定位诊断的检验和补充。肿瘤切除是胰岛素瘤的主要术式,腹腔镜胰岛素瘤切除应得到推崇。
Objective To investigate the diagnosis and treatment of insulinoma. Methods The clinical data of 22 cases of insulinoma treated by Rui Ci Hospital of Nantong and First People’s Hospital of Nantong during the past 15 years were retrospectively analyzed. Results The whole group of 22 patients had Whipple triad. The positive rates of preoperative B-ultrasound, CT, MRI and portal venous thrombolysis were 15.8% (3/19), 67.5% (10/16), 71.4% (5/7), 100% 2/2). The positive rate of B-ultrasonography was 85.7% (6/7). Tumor resection in 13 cases of local excision in 3 cases, pancreatectomy + spleen excision in 1 case, pancreatoduodenectomy in 1 case, retained the duodenum in the pancreas resection in 1 case, laparoscopic insulinoma Three cases were excised. 22 cases were benign tumors. Postoperative hypoglycemia symptoms disappeared. Conclusion Whipple triad combined with the determination of IRI / G ratio is the main basis for qualitative diagnosis. Multi-slice spiral CT double-phase pancreatic lamellar scanning is the main means of diagnosis, intraoperative ultrasound is the diagnosis and preoperative positioning of the test and supplement. Tumor resection is the main surgical method of insulinoma, laparoscopic excision of insulinoma should be respected.